Nephrotic syndrome

Question 1

DESCRIPTION

Answer 1

Glomerular disease characterised by:

1. Severe proteinuria, i.e.: PCR >0.25 g/mmol
   AND
2. Oedema,
3. Hypoalbuminemia
4. Hyperlipidaemia.

The cause cannot be determined accurately without a biopsy.

Question 2

General Measures

Answer 2

1. Regulate salt and fluid intake.
2. Weigh regularly to assess fluid retention.
3. Check for postural hypotension to identify excessive diuresis.
4. Evaluate proteinuria with PCR:
   a) initially – weekly
   b) when discharged – monthly, until stable
5. Monitor potassium frequently for patients on ACE-inhibitors and/or diuretics.

Question 3

Medicine treatment

Answer 3

Management should be guided by a specialist.

Question 4

Consultation/Referral

Answer 4

All patients

Question 5

1. A 6 year old male is diagnosed with nephrotic syndrome. In your nursing care plan you will include which of the following as a nursing diagnosis for this patient?*

A. Risk for infection
B. Deficient fluid volume
C. Constipation
D. Overflow urinary incontinence

Answer 5

The answer is A. A patient with nephrotic syndrome is at risk for infection due to the potential loss of proteins (immunoglobulins) in the urine that help fight infection. In addition, medication treatment for nephrotic syndrome may include corticosteroids or immune suppressors, which will further suppress the immune system. Option B is wrong because the patient will be experiencing fluid volume overload (not deficient). Option C and D are wrong because constipation and overflow urinary incontinence are not common findings with nephrotic syndrome.

Question 6

2. Which patient below is NOT at risk for developing nephrotic syndrome?

A. An 8 year old male with diabetes mellitus.
B. A 5 year old female diagnosed with minimal change disease.
C. A 10 year old male with Lupus.
D. A 7 year old male recently diagnosed with Goodpasture’s Syndrome.

Answer 6

The answer is D. The patients in options A-C are all at risk for nephrotic syndrome. The patient in option D is at risk for acute glomerulonephritis

Question 7

3. You’re collecting a urine sample on a patient who is experiencing proteinuria due to nephrotic syndrome. As the nurse, you know the urine will appear:*

A. Tea-colored
B. Orange and frothy
C. Dark and foamy
D. Straw-colored

Answer 7

The answer is C. The urine will appear dark and foamy due to the high amount of proteins present in the urine. Remember in nephrotic syndrome the patient is losing a massive amount of protein per day (3 grams per day) and this will cause the urine to foam.

Question 8

4. The mother of a child, who was recently diagnosed with nephrotic syndrome, asks how she can identify early signs that her child is experiencing a relapse with the condition. You would tell her to monitor the child for the following: Select-all-that-apply:

A. Weight loss
B. Protein in the urine using an over-the-counter kit
C. Tea-colored urine
D. Swelling in the legs, hands, face, or abdomen

Answer 8

The answers are B and D. The patient will NOT experience weight loss but weight GAIN as a sign of relapse with this condition. In addition, the urine will appear dark and foamy. Tea-colored urine indicates there is blood in the urine, which is NOT common with nephrotic syndrome.

Question 9

5. You’re providing education to a group of nursing students about nephrotic syndrome. A student describes the signs and symptoms of this condition. Which signs and symptoms verbalized by the student require you to re-educate the student about this topic? Select-all-that-apply:

 A. Slight proteinuria
 B. Hypoalbuminemia
 C. Edema
 D. Hyperlipidemia
 E. Tea-colored urine
 F. Hypertension

Answer 9

The answers are A, E, and F. The patient with nephrotic syndrome will experience massive proteinuria (not slight) along with low albumin in the blood (hypoalbuminemia), edema, and high cholesterol and triglyceride levels. It is not common for the patient to experience tea-colored urine or hypertension (rare) this is very common with acute glomerulonephritis.

Question 10

7. As the nurse, you know that it is important to implement a low sodium diet for a patient with nephrotic syndrome. However, it is important to implement what other type of diet due to another complication associated with this syndrome?

A. Low-phosphate
B. Low-fat
C. High-carbohydrate
D. Low-potassium

Answer 10

The answer is B. Patients with nephrotic syndrome can experience hyperlipidemia. Why? Remember that in this condition there will be low amounts of albumin in the blood. This decrease of albumin in the blood causes the liver to make more albumin, BUT while it does this it also makes more cholesterol and triglycerides…hence increasing lipid levels. Therefore, the patient should follow a low-sodium and low-fat diet as well.

Question 11

6. You’re providing care to a 6 year old male patient who is receiving treatment for nephrotic syndrome. Which assessment finding below requires you to notify the physician immediately?

A. Frothy, dark urine

B. Redden area on the patient’s left leg that is swollen and warm

C. Elevated lipid level on morning labs

D. Urine test results that shows proteinuria

Answer 11

The answer is B. Patients with nephrotic syndrome are at risk for hypercoagulability (blood clot formation) due to the loss of proteins in the urine that prevent blood clot formation. Option B represents a possible deep vein thrombosis, which will appear as a redden, warm, and swollen area on the extremity. Options A, C, and D are common findings with nephrotic syndrome, which are expected.